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Computed tomography of hepatic venous hypertension: the reticulated-mosaic pattern
M A Mauro1, D J Stackhouse, L A Parker
1Department of Radiology, University of North Carolina School of Medicine, Chapel Hill 27514.
Insights
A reticulated-mosaic liver pattern on CT scans can indicate hepatic venous hypertension in patients with heart failure or constrictive pericarditis. This finding, seen in 4 of 20 patients, involves contrast reflux into the vena cava and hepatic veins.
Area of Science:
- Radiology
- Hepatology
- Cardiology
Background:
- Constrictive pericarditis and congestive heart failure can lead to elevated venous pressures.
- Hepatic venous hypertension is a condition affecting liver blood flow.
- Distinguishing causes of abnormal liver enhancement is clinically important.
Purpose of the Study:
- To identify imaging findings of hepatic venous hypertension in patients with constrictive pericarditis or congestive heart failure.
- To describe the reticulated-mosaic pattern of the liver on contrast-enhanced computed tomography (CECT).
- To assess the association between this pattern and reflux into the inferior vena cava and hepatic veins.
Main Methods:
- Retrospective review of contrast-enhanced computed tomography (CECT) scans.
- Analysis of 20 patients with constrictive pericarditis or congestive heart failure.
- Identification and characterization of liver enhancement patterns and venous reflux.
Main Results:
- A reticulated-mosaic liver pattern was observed in 4 out of 20 patients.
- Contrast reflux into the inferior vena cava and hepatic veins was seen in 3 of these 4 patients.
- This pattern suggests hepatic venous hypertension.
Conclusions:
- The reticulated-mosaic liver pattern on CECT, associated with caval and hepatic venous contrast reflux, is indicative of hepatic venous hypertension.
- This imaging finding should not be confused with other causes of inhomogeneous liver enhancement.
- Radiologists should consider hepatic venous hypertension in patients with these CT findings and relevant clinical conditions.
Abstract:
A reticulated-mosaic pattern of the liver was identified on contrast-enhanced computed tomography in 4 of 20 patients with constrictive pericarditis or congestive heart failure. Reflux of contrast into a distended inferior vena cava and the hepatic veins was identified in 3 of the 4 patients. This abnormal enhancement pattern combined with hepatic venous or caval reflux of contrast indicates the presence of hepatic venous hypertension, and should not be mistaken for other abnormalities that may result in inhomogeneous hepatic enhancement.